Provider Demographics
NPI:1902328446
Name:SHECHTMAN-CORY, ELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:SHECHTMAN-CORY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60423
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0423
Mailing Address - Country:US
Mailing Address - Phone:650-353-7615
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL STE 115
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1406
Practice Address - Country:US
Practice Address - Phone:650-353-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical